Ann Acad Med Singap
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Ann Acad Med Singap · Jul 1996
Ideal endotracheal tube placement by referencing measurements on the tube.
The ideal position of the endotracheal tube (ETT) within the trachea is 5 +/- 2 cm from the carina with the head and neck in neutral position (Goodman's criteria). We assessed the possibility of achieving ideal placement of ETTs in our population by positioning them at reference marks of 23 cm in men and 21 cm in women. From January 1995 to April 1995, 105 intubated patients in the Medical Intensive Care Unit, Singapore General Hospital were studied. ⋯ Five cases (4.8%) had ETT tip > 7 cm from the carina. Adopting the above-mentioned reference marks did not result in ideal positioning of ETTs in a significant proportion of cases (33.4%). We postulate that this is because our Asian population is generally shorter than those in previous studies which had achieved ideal ETT positioning using similar reference marks.
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Ann Acad Med Singap · Jul 1996
Unplanned returns to the accident and emergency department--why do they come back?
An audit of unplanned returns by patients to the Accident and Emergency Department was carried out recently in Toa Payoh Hospital. This was done for a period of eleven months for the year 1994. A total of 166 unplanned patient returns were studied. ⋯ Another 14.5% of patients were found to have wrong or missed diagnoses at the initial visit, the two most important of which were appendicitis and bleeding from the gastrointestinal tract. It is hoped that such an audit will serve to identify areas for improvement in patient care. It can also be a useful tool for measuring and improving the performance of individual Emergency Room doctors, or a group of doctors.
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Ann Acad Med Singap · Mar 1996
Case ReportsAsystole following laryngoscopy and endotracheal intubation: a case report.
Severe bradycardia and asystole are very rare complications following laryngoscopy and endotracheal intubation. In this report, we describe a case in which these life-threatening complications occurred in a healthy male during induction of general anaesthesia. Activation of vagal reflexes during manipulation of the airway and the use of vagotonic drugs at induction are the mechanisms postulated to be responsible for these phenomena. Analysis of heart rate variability measurements may be useful in identifying patients at risk for development of these haemodynamic alterations during the induction of anaesthesia so that appropriate drugs and monitoring can be administered.
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Ann Acad Med Singap · Jan 1996
The scapular manipulation method for reducing anterior shoulder dislocations.
Anterior dislocation of the shoulder is the most common dislocation encountered by the emergency room medical officer. Many of the present methods employed, such as Kocher's method, the Hippocratic method and distraction method, necessitate the use of both intravenous pethidine and midazolam, which prolongs the recovery time of the patient in the emergency room, as well as carrying the risk of respiratory depression. Also, such methods are associated with complications such as fractures of the humerus and injury to the axillary vessels and brachial plexus. ⋯ This was a descriptive study. The method was found to have a high success rate (78.4%), was easy to teach, did not rely on the use of strong intravenous sedative agents, and was free of complications. Our experience with this method compared favourably with that of another large series which had a success rate of 79%.